asked the Minister for Health if he will give a direction under section 38 of the Health Act, 1970, to the Midland Health Board to ensure that the County Hospital, Tullamore, County Offaly, will not be downgraded in capacity, services or status.

In September, 1973, Comhairle na nOspidéal produced guidelines which they believed should underpin future general hospital development in this country. In summary, the guidelines provided that future general hospital planning should be based on three basic principles. These were: that acute hospital services should be organised so that the population served would be within 30 miles of a hospital centre; that the minimum staffing levels in each hospital would consist of two consultant surgeons, two consultant physicians and other consultant staff as required by the hospital's caseload; and that a minimum scale hospital should usually serve a population of about 100,000.

I accepted these guidelines as reasonable in Irish circumstances. On 9th October, 1973, I issued a memorandum to the chairmen and members of each health board, each regional hospital board and Comhairle na nOspidéal in which I outlined the guidelines and asked that working parties representative of these agencies be set up for each health board area to prepare options for hospital development within the context of the guidelines.

I should say at this point that no health agency, including the Midland Health Board and the County Offaly health advisory committee, questioned the validity of these guidelines as a basis for future hospital development. Within the context of the guidelines, the working party for the Midland Health Board area, which included representatives of the Opposition party, put forward three options for future hospital development. These were—

(a) one large general hospital at Tullamore,

(b) two smaller general hospitals at Mullingar and Portlaoise,

(c) two smaller general hospitals at Athlone and Portlaoise.

These options were submitted, inter alia, to the Midland Health Board and the Laois, Longford, Offaly and Westmeath local health advisory committees for their consideration. Even at this point, I am not aware that any of these agencies questioned either the guidelines or the options which arose from them. Rather each agency was concerned to choose the option which it thought best.

Following their consideration of the options, the Laois, Longford and Westmeath health advisory committees agreed unanimously to support two hospitals at Portlaoise and Mullingar. It is clear that there was no party political disagreement in these counties. The Offaly County Health Advisory Committee favoured a single hospital in Tullamore. In the case of the Midland Health Board, they decided in favour of two hospitals, one each in Portlaoise and Mullingar, with members of all political parties voting on non-party lines.

Following this exercise in intensive consultation with the relevant health agencies, it was clear that majority opinion in the Midland Health Board area favoured hospitals in Portlaoise and Mullingar. The Government accepted this view since it was fully democratic and since it was fully in accordance with the guidelines I had issued, which had not been disputed by any health agency.

If I were to seek to reverse the Government's decision on the matter now, I would be flaunting democratic opinion in the midland area. If the Midland Health Board and the other local health agencies had recommended to me that Tullamore hospital should be developed instead of Portlaoise and Mullingar hospitals, I think the Government would have accepted that democratic recommendation, because it too would have been within the guidelines issued. This was not the case, however. If the Government were to reverse their decision now and develop Tullamore uniquely, the people of Laois, Westmeath and Longford would rightly say that we were reversing a democratic recommendation made by their representatives, including representatives from all political parties.

Tullamore Hospital will be retained in its present capacity for many years to come. Subsequently, it will become a community hospital. As such, it will provide consultant staffed out-patient clinics in medicine, surgery, obstetrics, gynaecology and psychiatry. Radiology, pathology and physiotherapy will be available for both out-patients and in-patients. The question of what other services it could provide will be discussed in detail with the health board in the meantime and it will be open to the board to prepare proposals in relation to these.

As soon as a development programme is carried out on the Portlaoise and Mullingar hospitals, the County Hospital at Tullamore will then be a community hospital?

That is correct.

As it is the policy of Fianna Fáil to maintain Tullamore as a general hospital, would the Minister even at this late stage not reprieve it, as this is a very vexed question in Offaly?

I appreciate that but, as I have said on many other occasions, I would not ask the Government to change their policy in regard to the siting of these hospitals.

Has the Minister received a communication from Offaly County Council asking him to meet a deputation on this matter and, if so, would he oblige?

I am sorry but I would not, and I do not mean any offence to Offaly County Council or any other public body or organisation. But, as I told the Deputy and the House previously, I took the precaution before a decision was made of receiving any deputation which asked to see me. In all, I saw about 21. They put their cases before me but unfortunately some of those who wanted to have a hospital sited in a certain area had to be disappointed because, as I said in the reply, if Tullamore were to be regarded as an acute general hospital it would upset the guidelines not only in the Midland Health Board but in other areas as well. I should point out that it was a decision that was not taken against Tullamore but a decision taken by the Midland Health Board in which they voted by an overwhelming majority for the upgrading of Portlaoise and Mullingar. I accepted that as a democratic decision, but I can understand the feelings of the people of Tullamore and Offaly. I should say in respect of the decision made, the people of Leix and Offaly and the Midland Health Board area generally can be assured of a very good hospital service.

Is the Minister aware that there is a staffing problem in the County Hospital in Tullamore now in view of the fact that there is a cloud over it and that it has been downgraded?

The Deputy says that. I do not think there should be because I think it will be recognised in respect of all hospital development that it will take many years. There are priorities in various areas that have to be attended to first as far as the building and expansion of hospital services are concerned. As I said in the reply, Tullamore hospital will retain its present capacity and use and fulfil the same role as previously for several years to come. It takes quite some time to plan a project like this and have it finalised. I could not put a number of years on the time when the other two hospitals will be completed but it will take quite a number of years before the status of Tullamore will become that of a community hospital.

I notice that in the Minister's original reply he said that the question of other services would be considered. Is the Minister aware that a study has been carried out recently in regard to orthopaedic surgery and that the Midland Health Board area will be included in that study and that the report may be furnished in the next few days?

I am not so aware. I know that discussions are going on with Tullamore hospital but I could not say what aspects are being considered.

I did not hear the Minister's reply.

I said that, as in the case of all hospitals that will become community hospitals, there will be discussions between the Department and the health boards as to what their actual role will be apart from what I read out here in respect of community hospitals.